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General NPI Number Information
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NPI Number | 1902064207
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Entity Type | Individual
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Provider Name | BRENT CHESTER PHD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 800 E CYPRESS CREEK RD SUITE 202
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-3522
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Country | US
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Telephone | 954-771-8903
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Fax | 954-771-8905
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Provider Business Mailing Address
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Address Line | 7100 PINES BLVD SUITE 23
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-7355
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Country | US
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Telephone | 954-967-0107
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Fax | 954-967-0109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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